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Feb. 25, 2016 11:49AM No, 8337 P. 9/56 <br />Barnett Medical Ses, Inc 510-429-9911 Ph Date: 02/uv4u 93 <br />30820 San Antonio* 510-429-9914 Fax* Manifest #: 67$75 <br />' Hayward Ca 94544 San Joaquin County Customer# 2560 <br />svt— otter ID#4b9 <br />'°'U i' • c p Environmental Health Department DIRECTOR <br />Linda AW10VO a760 <br />86 Eastq)IVton Ave die <br />�n Care CentegfQ_ivnPROGRAM COORDINATORS <br />r Ci` <br />E( o3d Rii p�ML�232 tEveekly j Robert McClellon, REHS <br />We r Month FLAT -RATE Jeff Carruesco, REHS, RDI <br />Website: 9nId�6 Aigov.org/eha� Kasey Foley, REHS <br />C% F p'Ft Adrienne Ellsaesser, REHS <br />Phone: (209) 468-3420 Rodnev Estrada-REHS <br />o Destination Facility q Alternate Deatlnetkm Fa1440-A <br />Alternate Transfer Facility <br />Photo Weate Recycling Ino Curtis Bay Energy Daniela 3harpemBrt <br />aaaoKernarelyalcC 3200HawklnePointRd at4ar,Therese Ave <br />Sen Rafael CA 64901 BattlmorA MD 2!229 Fre <br />Fax: (209 <br />o TraWar Facility: <br />N Destination Facility: <br />a Allernale Transfer F <br />Bernen Medical Ser-Aces,lnc <br />samett Medlcal Servlces,lnc <br />Healthwim seMces <br />30920 5an Antonio St <br />2365 Arch Rd 0200 <br />4800 E, Lincoln Ave <br />Hayward CA 94544 <br />Stockton GA 96216 <br />Fowler CA 09626 <br />(610) 429-9911 <br />(610) 420.0011 <br />55M�14.33n <br />Permit 9 TS -87 <br />permit 0 TS/OST-106 <br />Permit 0 TM9 <br />12 gal <br />4 gal <br />Date <br />_ V, Dete��L <br />o Destination Facility q Alternate Deatlnetkm Fa1440-A <br />Alternate Transfer Facility <br />Photo Weate Recycling Ino Curtis Bay Energy Daniela 3harpemBrt <br />aaaoKernarelyalcC 3200HawklnePointRd at4ar,Therese Ave <br />Sen Rafael CA 64901 BattlmorA MD 2!229 Fre <br />Waste Collected: UN 3291 Regulated Medical Waste n.o.s. 6.2 PG II <br />Sharps Containers <br />Regulated Medical Waste <br />Pharmaceutical <br />Trace Chemotherapy <br />sno CA 93725 <br />(415)459-8807 <br />(490)350-3226 <br />34.6252 <br />Permit # PWR 922764 <br />Permit # 2005-WMI-0036 <br />Permit #TS/0ST-55 <br />Waste Collected: UN 3291 Regulated Medical Waste n.o.s. 6.2 PG II <br />Sharps Containers <br />Regulated Medical Waste <br />Pharmaceutical <br />Trace Chemotherapy <br />Size Qty: <br />Size Qty: Wt <br />Size Qty: <br />Wt: <br />Size Qty; WI: <br />Up to: <br />3 gal <br />2 gel <br />20 gal <br />8 gal <br />12 gal <br />4 gal <br />38 gal T <br />9 gal <br />18 gal <br />6 gal <br />40 gal / �� <br />12 gal <br />20 gal <br />8 gal <br />44 gal <br />18 gal <br />38 gal <br />12 gal <br />Size Qty <br />Weight <br />11�Tal <br />Pathogen: <br />Product Delivered: <br />weight: <br />Item 4 Description: Qt; <br />Dental Waste: <br />Amalgam;Size QtyFixer:Size Qty DQveloper:Siza Qty <br />Lead:Slze Q>__ Other:Size qt_.,, <br />Other: Tvpe Size at <br />Notes: , r.— '.1w. . <br />@a addl tub beyond (Q) <br />Generator Certification: <br />Generator (Customer) <br />Route Driver <br />rte. <br />Certificate ofDestniction <br />Incineration <br />I hereby certify that the contents of this con sgnmentare fully and accurately described above by proper shlpping name <br />and are classified, packed, marked, and labeled, and are in all aspects in pro per condition for transport according to <br />applicable goreernmeritregulations. <br />I furtherdedare that this shlpment of waste is free of hazardoueand meralrywaste as deFlned by the US code o ffederal <br />regulations and/or appropriate state rules and regulations_ j <br />Name of au orltad parson (prind , �gnature Dace <br />Name of authorlied person (prin 0 96nature 6ate <br />Name of authorized parson (pllmt) <br />Brett Espicha <br />Date <br />02/04/2015 <br />Certificate of Destruction <br />Autoclaved Nemo of sutholized parson (print) -�ignature Date <br />Recelved Time Feb,25, 2016 11:52AM No -1498 <br />